Embodiments of the present system and method relate generally to electronic communications in a healthcare setting. Particularly, certain embodiments relate to providing site-specific, customizable data transfer for imaging devices using the Digital Imaging and Communications in Medicine (DICOM) information model.
Clinics, hospitals, and other healthcare facilities have come to rely more and more on computers over the last several decades. In particular, healthcare facilities employ certain types of digital diagnostic imaging modalities, such as computed tomography, magnetic resonance imaging, ultrasound imaging, and X-ray imaging. Many different manufacturers developed digital diagnostic imaging modalities to gather and transmit diagnostic information, and each manufacturer employed a different, sometimes proprietary, way of handling the digital information. The method of handling information is often hardcoded into the digital diagnostic imaging modality, preventing an individual facility from reconfiguring the handling method to make the handling method uniform across a facility's diverse digital diagnostic imaging modalities. Thus, a single facility using imaging modalities manufactured by different vendors, or multiple facilities using different imaging modalities and seeking to share data, faces the possibility of having imaging modalities that produce different image formats.
A facility with imaging modalities producing different image formats is faced with a number of problems. For example, outputs of each imaging modality may be non-uniform, which may create difficulty for storage of images from different systems onto a single media type or a single server type. Additionally, diagnostic images associated with a single patient may be in different imaging formats, preventing easy electronic association of all diagnostic information with a single patient database record. Furthermore, different imaging modalities with different image formats may not be able to share a single scheduling system. That is, healthcare facilities often schedule imaging procedures to multiple and various imaging modalities through a single, centralized scheduling system, which offers the imaging modality certain information specific to a given patient. Thus, different image formats created an obstacle for a centralized data management system.
In response to the problem of different image data formats, The American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) formed a joint committee in 1983 to develop a standard image format. This standard, eventually known as Digital Imaging and Communications in Medicine (DICOM): 1) promoted communication of digital image information, regardless of device manufacturer; 2) facilitated the development and expansion of Picture Archiving and Communication Systems (PACS) that may also interface with other systems of healthcare information; and 3) allowed for the creation of diagnostic information data bases that may be queried by a wide variety of devices distributed geographically.
Recent enhancements in DICOM have made the standard more flexible. For example, DICOM is now applicable to a network environment, where the initial imaging format standards were applicable only to a point-to-point environment. This enhancement is possible because DICOM now supports operation through the industry standard networking protocol known as TCP/IP. In another enhancement, DICOM specifies how devices claiming conformance to the standard will react to the exchange of both commands and data. In doing so, DICOM specifies the semantics of commands and associated data.
Importantly, DICOM introduces explicit information objects, which are elements used in an object-oriented database management environment in contrast with a relational database management environment. The information objects are used not only for images data such as raw image files, graphics, and waveforms, but also for administrative data to be used for creating reports or output printing. For information objects, DICOM specifies an established technique for uniquely identifying any information object. The technique facilitates unambiguous definitions of relationships between objects as they are used throughout a network.
While the adoption of DICOM has made possible many improvements in the way in which imaging modalities communicate information across the network of a healthcare facility, certain limitations still exist. One limitation involves so-called “legacy” computer systems and in particular, legacy scheduling systems.
As mentioned above, healthcare facilities rely on computers to handle the tremendous amount of diagnostic, therapeutic, demographic, and administrative data created in the modern healthcare environment. In order to make the most efficient use of expensive equipment, healthcare facilities rely on scheduling and order-filling systems to regulate the workloads of expensive and high-demand equipment, such as the aforementioned digital diagnostic imaging modalities. Scheduling and order-filling systems create efficiency, for example, by supplying the imaging modality with information from the computer based patient records on the healthcare network that an imaging modality user would otherwise have to enter manually into the imaging modality in order to accurately associate the diagnostic image with the patient being diagnosed.
For example, within a Radiology department of a clinic, hospital, or other healthcare facility, a Radiology Information System (RIS) manages the business and execution of workflow within the department. Workflow is another name for the pool of actions to be taken that originate when a radiologist or other healthcare professional places an order for work to be performed by an imaging modality on a particular patient. In a Radiology department, the imaging modality may be an X-ray imaging device. In order to execute properly the workflow and return the appropriate diagnostic information, the RIS must communicate at minimum the patient's demographic information, the diagnostic procedure information, and the scheduling information to the X-ray imager. The diagnostic information that results from the scheduled imaging procedure must then be linked to the computer based patient record, along with all other pertinent patient information.
Unfortunately, the RIS of a given healthcare system may be a legacy system and not conform to DICOM. The legacy RIS may instead operate on a Health Level Seven (HL-7) based interface, for example. The healthcare facility is then unable to take advantage of the standardization offered by DICOM and must find a solution involving the legacy system. One expensive and unfavorable solution is to replace the entire scheduling system with a conforming system. This solution is unfavorable at least because the system is otherwise entirely suitable, operable, and familiar to the users.
Another solution is to code into the application logic of the RIS a method of communicating with each of the different DICOM-conforming imaging devices on the healthcare system network. The method of coding communication parameters for each imaging device on a network into the individual application logic of a RIS is time-consuming and specific to each device, therefore creating needless risks to the stability of the network and preventing generic application.
Another example of a drawback of the DICOM standard information model is that the standard necessarily prevents some site-specific customization, even in the case where the scheduling system is DICOM compliant. In particular, DICOM creates an entity-relationship model for communicating worklist items. A worklist item has a one-to-one relationship with a real-world object and is related to other objects from the real-world model. Attributes are defined for each entity in the entity-relationship model. For any worklist item request, the set of attributes is available where the attributes are specific to any entity that is necessary to fill the worklist item request. The method of querying the system for the attributes necessary to fill the worklist item request is through the use of keys.
Keys are the heart of the DICOM information exchange system and also the heart of the second limitation, namely a lack of system flexibility. The keys are predefined by DICOM and include items like scheduled procedure step sequence, scheduled station name, requested procedure code, and patient admission ID number. The keys control the identity of the information that may be communicated among schedulers and imaging modalities on the healthcare network. In some cases, information is hard-coded into the logic of the imaging modality by the manufacturer because of the universality of the DICOM standard. Unfortunately, given the increasing complexity of procedures, the explosion of administrative information associated with a given patient, and the increasing number of devices capable of interfacing with the healthcare network, more flexibility is required in order to achieve greater efficiency.
One system currently in use was developed by Mitra and is available through Agfa Healthcare. The Mitra system maps DICOM keys in a query to nonconforming information from a scheduling and/or order-filling system. However, the Mitra system maps a limited number of DICOM query keys. In the case of a legacy system, the few keys are insufficient to overcome the obstacles discussed above. Also, in a communication transaction, additional information about a client is transferred to a server in addition to the object of the query. The Mitra system allows for mapping of only DICOM query keys. Thus, in the case of site-specific customization, the limited number of mappable keys of the Mitra System does not provide sufficient flexibility, nor does the limited number of mappable keys allow for the capture of nonconforming information available on existing networks, such as network address.
There is a need for a system and method for customizable workflow management to provide for the capture of nonconforming information. There is a need for a system and method for integrating legacy systems into an industry standard information format, such as DICOM, with a generic interface rather than a system specific coding solution. There is a need for a system and method for optimizing workflow among conforming systems of a healthcare facility by generically reconfiguring the query system of DICOM, or other industry standard information formats.